Original ArticleDeterminants of White Matter Hyperintensity Burden Differ at the Extremes of Ages of Ischemic Stroke Onset
Section snippets
Patient Selection and Definitions
Study subjects were recruited as part of an ongoing hospital-based study of patients with ischemic stroke (IS).17 Consecutive patients aged 18 years of age or older admitted to the Massachusetts General Hospital Stroke Unit, including those admitted directly to the emergency department or transferred to the emergency department from a referring hospital, between July 2000 and December 2013 were considered for enrollment. Patients underwent clinical evaluation by a neurologist and diagnostic
Results
The mean age of 1008 consenting subjects with IS was 65.9 (±14.7) years of age; there were 249 (24.7%) PEOS, 448 (44.4%) PAAOS, and 311 (30.9%) PLOS (Table 1). Males represented 61.7% of the cohort. Median adjusted WMHv for all subjects was 6.0 cm3 (interquartile range, 2.7-12.5 cm3) and mean normalized WMHv was 1.8 (±1.1). WMHv and prevalence of AF, CAD, and history of TIA increased with age of stroke onset. A majority of subjects had HTN, except within the PEOS population (39.4%), which also
Discussion
In this analysis, we report that the determinants of WMH burden differ with age of stroke onset. Notably, history of tobacco use is an independent predictor of WMH severity specific to the youngest IS patients (PEOS), whereas age loses its effect as a determinant of WMHv in the elderly (PLOS). The importance of these novel data is that they are derived from the largest-to-date, hospital-based cohort of IS subjects with WMH severity quantified on brain MRI using a volumetric method and that they
Summary
In this cohort, history of tobacco use is a strong independent predictor of WMH burden in patients who experience IS before the age of 55 years, whereas female sex, HL, and current alcohol use, but not age, independently contribute to severity of WMH in those with stroke onset after 75 years of age. These findings suggest that the major risk factors for WMH and stroke differ across age groups and are modifiable. Future studies that target age-specific prevention strategies of symptomatic
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Cited by (0)
This study was supported by project grants from the American Heart Association Bugher Foundation, the Deane Institute for Integrative Research in Atrial Fibrillation and Stroke, Massachusetts General Hospital, and the National Institute of Neurological Disorders and Stroke (NINDS grants K23 NS064052 and R01 NS082285). C.R.Z., L.C., K.F., A.K., and A.M.A. report no disclosures. K.L.F. is supported by the NINDS (5P50NS051343-04). J.R. is supported by the NINDS (5R01NS059727, 5P50NS051343, R01NS063925) and the American Heart Association Bugher Foundation. N.S.R. is supported by the NINDS (K23NS064052 and R01NS082285).